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Br J Dermatol. 2019 Jun 30. doi: 10.1111/bjd.18265. [Epub ahead of print]

Topical treatments in atopic dermatitis: unexpectedly low use of emollients; use of topical corticosteroid is higher in juvenile patients, higher in male vs females, and shows independent associations with asthma and depression.

Author information

1
School of Medicine, University of Dundee, Medical School, Dundee, Scotland.

Abstract

BACKGROUND:

Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate-to-severe atopic dermatitis (AD) under real-world conditions are unknown. Thus, it remains unclear if inadequate use is widespread.

OBJECTIVE:

To quantify the use of TCS and emollients in moderate-to-severe AD.

METHODS:

Double-blinded drug prescribing recorded prospectively at the point of drug dispensing within a catchment of approx. 450,000 over a 31-year period in a population-based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over 12-month to minimize fluctuations.

RESULTS:

The resulting dataset was near-complete, and essentially free of reporting- and recording bias. Atopic co-morbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile (age < 16) compared to adult patients (49·2 vs. 38·1 gram / month), in males vs. females (46·8 vs. 29·7), and in patients receiving concurrent asthma treatment (40·4 vs. 26·7). TCS use was strongly associated with anti-depressant treatment. Emollient use was unexpectedly low at median of 9·6 gram/day (range 1·4 - 30·1). Results replicated in an independent validation cohort. Conclusions Deficient use of emollients may be a factor contributing to AD severity. TCS use does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure real-world impact of novel AD treatments. This article is protected by copyright. All rights reserved.

KEYWORDS:

atopic dermatitis; comorbidity; corticosteroid; database

PMID:
31257575
DOI:
10.1111/bjd.18265

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